Introduction: Obstructive Azoospermia (OA) is a surgically correctable cause of male infertility characterized by preserved spermatogenesis with impaired sperm transport. Microsurgical Vasoepididymal Anastomosis (VEA), particularly the Linear Intussusception Vasoepididymal Anastomosis (LIVEA) technique, remains the gold standard reconstructive procedure for epididymal obstruction. This study evaluated operative techniques, intraoperative findings, surgical challenges, and outcomes of microsurgical LIVEA performed at a tertiary andrology center in India. Materials and Methods: A prospective observational study was conducted between January 2025 and December 2025 at VNA Hospital, New Delhi, India. Ten consecutive patients diagnosed with obstructive azoospermia underwent scrotal exploration with intent for microsurgical VEA. Diagnosis was established using semen analysis, hormonal profile, physical examination, and Transrectal Ultrasonography (TRUS). Patients demonstrated normal testicular volume, palpable vas deferens, epididymal fullness, and preserved endocrine parameters. Microsurgical LIVEA was performed under 25× magnification when spermatozoa were identified intraoperatively from epididymal tubulotomy fluid. Postoperative semen analyses were performed at 3 and 6 months. Results: Bilateral sperm identification from epididymal fluid was achieved in six patients, while unilateral identification occurred in two patients. Reconstruction was abandoned in two patients because of absent epididymal sperm bilaterally. Bilateral LIVEA was performed in six patients and unilateral reconstruction in two patients. Dense epididymal adhesions were observed in two patients. Postoperative spermatozoa appeared in the ejaculate in four patients at 3 months and in five patients at 6 months. Patients undergoing bilateral reconstruction demonstrated comparatively better postoperative sperm recovery. No major perioperative complications were encountered. Conclusion: Microsurgical LIVEA is an effective reconstructive option for carefully selected patients with obstructive azoospermia. Successful outcomes depend upon meticulous patient selection, intraoperative sperm identification, and advanced microsurgical expertise. Early patency outcomes from our tertiary andrology center were comparable with contemporary international microsurgical VEA series.